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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701463
Report Date: 08/08/2024
Date Signed: 08/08/2024 02:55:23 PM

Document Has Been Signed on 08/08/2024 02:55 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:SONOMA VALLEY CARE HOME LLCFACILITY NUMBER:
342701463
ADMINISTRATOR/
DIRECTOR:		LOPES, MICHELEFACILITY TYPE:
735
ADDRESS:8936 SONOMA VALLEY WAYTELEPHONE:
(916) 821-4693
CITY:SACRAMENTOSTATE: CAZIP CODE:
95829
CAPACITY: 4CENSUS: 0DATE:
08/08/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Michele Lopes and Corissa Saylor, ApplicantTIME VISIT/
INSPECTION COMPLETED:
03:20 PM
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On 8/8/2024, Licensing Program Analyst (LPA) Tung Truong arrived announced to conduct a Pre-licensing inspection of the facility to ensure compliance with Title 22 regulations. LPA met with Applicants, Michele Lopes and Corissa Saylor who assisted LPA in today’s inspection.

It was learned that this facility will be licensed to serve up to 4 ambulatory clients. This facility will be vendored by Alta California Regional Center as a level 3 home. Facility has no clients at this time. LPA toured the facility with Michele Lopes and Corissa Saylor.

LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to clients. LPA observed the facility is clean and furnished. LPA observed rooms to have required furniture. Although there were no clients, food supplies of 2-day perishables and 7-day non-perishables were maintained. The temperature inside the facility was observed to be at 73*F which is within the required range of 68-85*F. Hot water temperature was measured at 113*F and is within the required range of 105-120*F. LPA observed knives and toxins to be locked away and inaccessible to clients. LPA observed smoke and carbon detectors were in good repair. LPA observed fire extinguishers and first aid kit were up to date. LPA observed the centrally stored medication areas to be locked and made inaccessible to the clients at this time. LPA observed no obstruction of emergency exits inside or outside of facility.

Based on a review of this facility during this Pre-licensing visit, it was determined that this facility was found to be in compliance at this time. Component III conducted with the applicant. LPA will notify the Central Application Bureau (CAB) that the pre-licensing has been completed and passed.

Per the California Code of Regulations Title 22, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was given to the applicant.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Tung Truong
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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